Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin and Clement J. Zablocki, VA, Medical Center, Milwaukee, Wisconsin.
NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.
Neurosurgery. 2019 Jan 1;84(1):66-76. doi: 10.1093/neuros/nyy003.
The influence of subtotal resection (STR) on neurocognitive function (NCF), quality of life, and symptom burden in glioblastoma is unknown. If bevacizumab preferentially benefits patients with STR is unknown.
To examine these uncertainties.
NCF and patient reported outcomes (PRO) were prospectively collected in NRG Oncology RTOG 0525 and 0825. Changes in NCF and PRO measures from baseline to prespecified times were examined by Wilcoxon test, and mixed effects longitudinal modeling, to assess differences between patients who received STR vs gross-total resection. Changes were also compared among STR patients on 0825 receiving placebo vs bevacizumab to assess for a preferential therapeutic effect. Overall survival between STR and gross-total resection patients was compared using the Kaplan-Meier method.
A total of 427 patients were eligible with STR present in 37%. At baseline, patients with STR had worse NCF, worse MD Anderson Symptom Inventory Brain Tumor Neurological Factor ratings (P = .004), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (P = .002). Longitudinal multivariate analysis associated STR with worse NCF (Hopkins Verbal Learning Test-Revised Delayed Recognition [P = .048], Trail Making Test Part A [P = .035], and Controlled Oral Word Association [P = .049]). One hundred eighty-three STR patients from 0825 were analyzed (89 bevacizumab, 94 placebo); bevacizumab failed to demonstrate improvement in select NCF or PRO measures.
STR patients had worse NCF and PROs before therapy. During adjuvant therapy, STR patients had worse objective NCF, despite accounting for tumor location. STR did not result in a detriment to OS. The addition of bevacizumab did not preferentially improve PRO or NCF outcomes in STR patients.
目前尚不清楚次全切除（STR）对胶质母细胞瘤患者的神经认知功能（NCF）、生活质量和症状负担的影响，如果贝伐珠单抗优先使 STR 获益，其获益患者的特征也尚不明确。
为了检验这些不确定性。
NRG 肿瘤学 RTOG 0525 和 0825 前瞻性地收集了 NCF 和患者报告的结局（PRO）数据。采用 Wilcoxon 检验和混合效应纵向模型，从基线到预设时间点，对 NCF 和 PRO 测量的变化进行评估，以比较接受 STR 与全切除患者之间的差异。还比较了 0825 中接受安慰剂与贝伐珠单抗治疗的 STR 患者之间的变化，以评估是否存在治疗效果的差异。采用 Kaplan-Meier 法比较 STR 和全切除患者的总生存。
共有 427 例患者符合条件，其中 37%存在 STR。基线时，STR 患者的 NCF 更差，MD 安德森症状调查脑肿瘤神经因子评分（P =.004）和欧洲癌症研究与治疗组织生活质量问卷（P =.002）更差。多变量纵向分析显示 STR 与 NCF 更差相关（霍普金斯词语学习测验修订版延迟识别[P =.048]，连线测试 A[P =.035]，和词语流畅性测试[P =.049]）。分析了来自 0825 的 183 例 STR 患者（89 例贝伐珠单抗，94 例安慰剂）；贝伐珠单抗未能改善特定的 NCF 或 PRO 指标。
STR 患者在治疗前的 NCF 和 PRO 更差。在辅助治疗期间，尽管考虑了肿瘤位置，STR 患者的客观 NCF 仍更差。STR 并未导致 OS 受损。贝伐珠单抗的加入并没有使 STR 患者的 PRO 或 NCF 结局得到优先改善。
